Academic Journal
Intraoperative surgical versus preoperative ultrasound‑guided adductor canal block for analgesia after total knee arthroplasty: A randomized trial.
| Τίτλος: | Intraoperative surgical versus preoperative ultrasound‑guided adductor canal block for analgesia after total knee arthroplasty: A randomized trial. |
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| Συγγραφείς: | David B; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France; Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France. Université Côte d'Azur, Nice, France., Peras M; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France; Hôpital d'Instruction des Armées Sainte-Anne, 2 boulevard Sainte-Anne, 83000 Toulon, France., Haseny B; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France., Badia E; Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France. Université Côte d'Azur, Nice, France., Neble A; Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France. Université Côte d'Azur, Nice, France., Bronsard N; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France., Gonzalez JF; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France., Maurice-Szamburski A; Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France. Université Côte d'Azur, Nice, France., Micicoi G; Institut Universitaire Locomoteur et du Sport (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06100 Nice, France. Electronic address: micicoi.g@chu-nice.fr. |
| Πηγή: | Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2026 Jun; Vol. 112 (4), pp. 104659. Date of Electronic Publication: 2026 Mar 18. |
| Τύπος έκδοσης: | Comparative Study; Equivalence Trial; Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Masson SAS Country of Publication: France NLM ID: 101494830 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1877-0568 (Electronic) Linking ISSN: 18770568 NLM ISO Abbreviation: Orthop Traumatol Surg Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Issy les Moulineaus, France : Elsevier Masson SAS |
| Ιατρικοί όροι (MeSH): | Arthroplasty, Replacement, Knee*/adverse effects , Intraoperative Care*/methods , Nerve Block*/methods , Postoperative Pain*/prevention & control , Ultrasonography, Interventional*, Anesthetics, Local/administration & dosage ; Preoperative Care/methods ; Ropivacaine/administration & dosage ; Aged ; Female ; Humans ; Male ; Middle Aged ; Analgesics, Opioid ; Length of Stay ; Pain Measurement |
| Περίληψη: | Background: Adductor canal block (ACB) offers opioid-sparing analgesia after total knee arthroplasty (TKA), with limited quadriceps weakness. A practical alternative is a surgeon‑performed intraoperative ACB. This study aimed to evaluate: (Q1) Does surgical ACB (S-ACB) reduce pain at rest 24 h after TKA versus anesthesiologist‑performed ultrasound‑guided ACB (US‑ACB)?, (Q2) Does S-ACB reduce 24‑h opioid consumption?, (Q3) Are there differences in early pain, rescue blocks, or adverse events?, (Q4) Does S-ACB impact length of stay (LOS)? Hypothesis: We hypothesized that S-ACB would be superior to US-ACB in reducing rest pain at 24 h after TKA. Material and Methods: Single-center, randomized, open-label trial of adults undergoing unilateral primary TKA (January 2025-June 2025). Patients were randomized 1:1 to S‑ACB (intraoperative injection into the adductor canal using predefined anatomical landmarks) or US‑ACB (preoperative in‑plane injection adjacent to the femoral artery, beneath vastus medialis). Both groups received 15 mL ropivacaine 0.475% for ACB and 40 mL ropivacaine 0.2% posterior capsular infiltration. The primary outcome was NRS pain at rest 24 h. Secondary Outcomes: included 24-h morphine consumption, NRS in post-anesthesia care unit (PACU), at post-operative day 3 (POD3), last in-hospital, rescue block, adverse events, and length of hospital stay (LOS). Intention‑to‑treat analyses were performed. Results: Fifty‑one TKAs were analyzed (S‑ACB n = 27; US‑ACB n = 24). Baseline characteristics were balanced except for diabetes (more frequent in US-ACB). Primary Outcome: mean 24‑h NRS was 1.6 ± 1.8 (S‑ACB) vs 2.0 ± 2.2 (US‑ACB); mean difference -0.33 (S‑ACB-US‑ACB), 95% CI -1.44 to 0.78; not statistically significant. 24‑h morphine: 5.6 ± 4.0 mg (S‑ACB) vs 5.8 ± 3.7 mg (US‑ACB); difference -0.16 mg, 95% CI -2.67 to 2.37 mg; not significant. No block‑related adverse events occurred. Rates of rescue block were low (two in US‑ACB). LOS was similar (6.5 ± 3.1 vs 6.7 ± 2.4 nights). Across timepoints (PACU, POD3, discharge), NRS and opioid use did not differ. Discussion: Surgical ACB did not provide superior analgesia compared to US-ACB at 24 h, with low pain scores and opioid needs overall and no safety issue. Larger multicenter trials are warranted to confirm equivalence and explore functional recovery. Level of Evidence: II; Randomized trial. (Copyright © 2026 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.) |
| Competing Interests: | Declaration of competing interest JFG is a consultant for Amplitude; NB is a consultant for Si-Bone; G Micicoi is associate editor for Orthopaedics & Traumatology: Surgery & Research and perceive grants from Johnson & Johnson, United Orthopedic and Adler. The other authors declare no competing interests. |
| Contributed Indexing: | Keywords: Femoral nerve block; Infiltration analgesia; Intraoperative adductor canal block; Knee replacement; Nerve block; Regional analgesia |
| Substance Nomenclature: | 0 (Analgesics, Opioid) 0 (Anesthetics, Local) 7IO5LYA57N (Ropivacaine) |
| Entry Date(s): | Date Created: 20260319 Date Completed: 20260526 Latest Revision: 20260528 |
| Update Code: | 20260529 |
| DOI: | 10.1016/j.otsr.2026.104659 |
| PMID: | 41856205 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1877-0568 |
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| DOI: | 10.1016/j.otsr.2026.104659 |